CARN Nursing Interventions and Treatment 2 — Questions and Answers
Question 1: A patient in alcohol withdrawal scores 15 on the CIWA-Ar. Which medication is the first-line pharmacological intervention?
- Haloperidol
- Lorazepam (Correct answer)
- Naltrexone
- Disulfiram
Correct answer: Lorazepam
Benzodiazepines such as lorazepam are first-line agents for managing moderate-to-severe alcohol withdrawal due to their cross-tolerance with alcohol at GABA receptors.
Question 2: Which nursing intervention is most important when administering methadone in an opioid treatment program (OTP)?
- Administer the dose intramuscularly to ensure absorption
- Observe the patient swallow the dose to confirm ingestion (Correct answer)
- Allow the patient to take the dose home after the first visit
- Hold the dose if the patient appears intoxicated without further assessment
Correct answer: Observe the patient swallow the dose to confirm ingestion
Direct observation of methadone ingestion (DOT) is required at OTPs to prevent diversion and confirm therapeutic dosing.
Question 3: A nurse is planning brief motivational interventions for a patient identified through SBIRT screening. What does SBIRT stand for?
- Screening, Brief Intervention, and Referral to Treatment (Correct answer)
- Substance-Based Integrated Rehabilitation and Therapy
- Standardized Behavioral Intervention and Recovery Tracking
- Structured Brief Interview for Relapse and Treatment
Correct answer: Screening, Brief Intervention, and Referral to Treatment
SBIRT is a public health framework—Screening, Brief Intervention, and Referral to Treatment—used across healthcare settings to address substance use disorders.
Question 4: A patient on buprenorphine/naloxone reports severe withdrawal symptoms 18 hours after their last heroin use. What is the priority nursing action before initiating the first dose?
- Administer the first dose immediately to relieve discomfort
- Confirm the patient is in moderate objective opioid withdrawal using a scale like COWS (Correct answer)
- Obtain a urine drug screen and wait 48 hours for results
- Contact the prescriber to switch to full-agonist methadone
Correct answer: Confirm the patient is in moderate objective opioid withdrawal using a scale like COWS
Buprenorphine induction must be delayed until the patient displays objective withdrawal signs (COWS ≥ 8–12) to prevent precipitated withdrawal.
Question 5: Which psychosocial intervention is specifically designed to enhance a patient's internal motivation to change addictive behaviors by exploring ambivalence?
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavior Therapy (DBT)
- Motivational Interviewing (MI) (Correct answer)
- 12-Step Facilitation Therapy
Correct answer: Motivational Interviewing (MI)
Motivational Interviewing is a patient-centered, directive counseling style designed to elicit and strengthen motivation for change by resolving ambivalence.
Question 6: A patient with opioid use disorder and HIV is starting medications for opioid use disorder (MOUD). Which MOUD has documented effectiveness in improving HIV antiretroviral therapy adherence?
- Naltrexone oral tablets
- Naloxone nasal spray
- Methadone or buprenorphine (Correct answer)
- Disulfiram
Correct answer: Methadone or buprenorphine
Both methadone and buprenorphine have been shown to increase retention in care and ART adherence in patients with co-occurring HIV and opioid use disorder.
Question 7: During a nicotine cessation counseling session, the nurse teaches the patient about nicotine replacement therapy (NRT). Which statement by the patient indicates a need for further teaching?
- I can use a patch and short-acting gum together for breakthrough cravings
- I should not eat or drink for 15 minutes before using nicotine gum
- I should stop NRT immediately if I smoke even one cigarette (Correct answer)
- I can use NRT even if I have cardiovascular disease after discussing with my doctor
Correct answer: I should stop NRT immediately if I smoke even one cigarette
A slip does not require stopping NRT; continuing NRT while addressing the lapse is more effective than abrupt discontinuation.
CARN Nursing Interventions and Treatment 2
A patient in alcohol withdrawal scores 15 on the CIWA-Ar.
Which medication is the first-line pharmacological intervention?